opretive dentistry

Upload By:Ahmed Ali Abbas

Babylon University College of Dentistry

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Operative Dentistry 2

Definition of Operative Dentistry

Operative dentistry is

the ART and SCIENCE of the

diagnosis, treatment, prognosis

of defects of teeth which do not

require full coverage restorations

for correction.

Indication of Operative Dentistry

Caries;

Malformed, discolored,

or fractured teeth;

Restoration replacement.

Program of Operative Treatment

Patient assessment

Examination and diagnosis

Treatment planning

Pain control: local anesthetic

Isolation of the operating field

Cavity preparation

Matrix application

Preparation of materials

Insertion and carving of materials

Finishing and Polishing

Program of Operative Treatment

Cavity Preparation

The mechanical alteration of a

defective, injured, or diseased tooth

in order to best receive a restorative

material which will re-establish a

healthy state for the tooth including

esthetic corrections where indicated,

along with normal form and function.

Cavity Structure

walls

angles

cavity

Classification of cavity

Class I

Class II

Class III

Class IV

Class V

Class VI

—G.V.Black in 1908

Cavity

Simple cavity: only one tooth

surface is involved.

Compound cavity: two surfaces

are involved.

Complex cavity: three or more

surfaces are involved.

QUIZ

TIME

Class 1

Class 2

Class 1

Class 2

Class 3

Class 4

Class 5

Class 6

Stages and Steps

in Cavity Preparation

Initial cavity preparation stage

Final cavity preparation stage

Initial cavity preparation stage

Step 1 Outline form and initial depth

Step 2 Primary resistance form

Step 3 Primary retention form

Step 4 Convenience form

Final cavity preparation stage

Step 5 Removal of any remaining infected

dentin if indicated

Step 6 Pulp protection

Step 7 Secondary resistance & retention form

Step 8 Procedure for finishing external walls

Step 9 Final procedures

Initial cavity preparation stage

Step 1 Outline form and initial depth

Step 2 Primary resistance form

Step 3 Primary retention form

Step 4 Convenience form

Outline Form and Initial Depth Ⅰ

Definition:

placing the cavity margins in the

positions they will occupy in the final

preparation;

preparing an initial depth of 0.2~0.8 mm

pulpally of the dentinoenamel junction

position or normal root surface position.

Maxillary Class Ⅰ outline form

Mandibular Class Ⅰ outline form

Maxillary Class Ⅱ outline form

Mandibular Class Ⅱ outline form

Common Error

Outline Form and Initial Depth Ⅱ

Principles: without any exception

all friable and/or weakened enamel

should be removed

all faults should be included

all margins should be placed in a

position to afford good finishing of

the margins of the restoration.

Outline Form and Initial Depth Ⅲ

Features:

preserving cuspal strength

preserving marginal ridge strength

minimizing facio-lingual extension

using enameloplasty

connecting two close faults or cavities

restricting the depth of the preparation

into dentin.

Initial cavity preparation stage

Step 1 Outline form and initial depth

Step 2 Primary resistance form

Step 3 Primary retention form

Step 4 Convenience form

Primary Resistance Form Ⅰ

Definition:

The shape and placement of the cavity

walls that best enable both the

restoration and the tooth to withstand,

without fracture, masticatory forces

delivered principally in the long axis of

the the tooth.

Primary Resistance Form Ⅱ

Principles:

To utilize the box shape with a relatively

flat floor to resist occlusal loading by

virtue of being at right angles to

mastication force;

To restrict the extension of the external

walls (keep as small as possible) to

allow strong cusp and ridge areas to

remain with sufficient dentin support;

Primary Resistance Form Ⅲ

Principles:

To have a slight rounding of internal

line angles to reduce stress

concentration in tooth structure;

To provide enough thickness of

restorative material to prevent its

fracture under load.

Primary Resistance Form Ⅳ

Feature:

Box shape

Relatively flat floors

Inclusion of weakened tooth structure

Preservation of cusps and marginal ridges

Rounded internal line angles

Adequate thickness of restorative materials

Reduction of cusps for capping if indicated

Initial cavity preparation stage

Step 1 Outline form and initial depth

Step 2 Primary resistance form

Step 3 Primary retention form

Step 4 Convenience form

Primary Retention Form Ⅰ

Definition:

The shape or form of the prepared

cavity that resists displacement or

removal of the restoration from

tipping or lifting forces.

In many respects retention and resistance form

are accomplished in the same cutting procedure.

Primary Retention Form Ⅱ

Principles: depending on the materials

Amalgam restoration:

developing external cavity walls that converge occlusally and dovetail design

The devotail design provide retention form

to the occlusal portion of the cavity.

The occlusal convergence of the walls offers

retention in the proximal portion of the cavity

against displacement occlusally.

Primary Retention Form Ⅲ

Principles: depending on the materials

Composite restoration:

a mechanical bond between the material

and conditioned, prepared tooth structure.

Initial cavity preparation stage

Step 1 Outline form and initial depth

Step 2 Primary resistance form

Step 3 Primary retention form

Step 4 Convenience form

Convenience Form Ⅰ

Conception:

The shape or form of the cavity that

provides for adequate observation,

accessibility, and ease of operation

in preparing and restoring the cavity.

Convenience Form Ⅱ

Principles:

Allow access for caries removal

Allow access for restoration placement

Allow access to margins for finishing,

evaluation and cleaning

Convenience Form

Final cavity preparation stage

Step 5 Removal of any remaining infected

dentin if indicated

Step 6 Pulp protection

Step 7 Secondary resistance & retention form

Step 8 Procedure for finishing external walls

Step 9 Final procedures

Removal of any remaining

infected dentin if indicated

Definition:

The elimination of any infected carious

tooth structure or faulty restorative

material left in the tooth after initial

cavity preparation.

Removal of dentinal caries using round burs and spoon excavators

Final cavity preparation stage

Step 5 Removal of any remaining infected

dentin if indicated

Step 6 Pulp protection

Step 7 Secondary resistance & retention form

Step 8 Procedure for finishing external walls

Step 9 Final procedures

Pulp protection

Using liners or bases

to protect the pulp or

to aid pulpal recovery or both.

Final cavity preparation stage

Step 5 Removal of any remaining infected

dentin if indicated

Step 6 Pulp protection

Step 7 Secondary resistance & retention form

Step 8 Procedure for finishing external walls

Step 9 Final procedures

Secondary resistance and

retention forms Ⅰ

Most compound and complex cavity

preparations require additional

resistance and retention form.

The exception being those preparations

that are very conservative.

Secondary resistance and

retention forms Ⅱ

Mechanical forms

Cavity wall conditioning form

Mechnical form:

Proximal locks

Proximal slots

Proximal locks

Slot on gingival wall

Final cavity preparation stage

Step 5 Removal of any remaining infected

dentin if indicated

Step 6 Pulp protection

Step 7 Secondary resistance & retention form

Step 8 Finishing external walls

Step 9 Final procedures

Finishing the external walls Ⅰ

Definition:

is the further development of a

specific cavosurface design and

degree of smoothness that produces

the maximum effectiveness of the

restorative material being used.

Finishing the external walls Ⅱ

Objectives:

To create the best marginal seal possible

between the restorative material and tooth

structure;

To afford a smooth marginal junction;

To provide maximum strength of both the

tooth and the restorative material at and

near the margin.

The strongest enamel margin is that margin

which is composed of full-length enamel rods

that are supported on the cavity side by shorter

enamel rods, all of which extend to sound dentin.

Finishing the external walls Ⅲ

The design of the cavosurface angle

The degree of smoothness of the wall

The design of the cavosurface angle:

depending on the material

amalgam: 90°

composite: beveling 30°~ 40°

Final cavity preparation stage

Step 5 Removal of any remaining infected

dentin if indicated

Step 6 Pulp protection

Step 7 Secondary resistance & retention form

Step 8 Procedure for finishing external walls

Step 9 Final procedures

Final procedures

cleaning

inspecting

varnishing

conditioning

Cavity preparation

Matrix application

Preparation of materials

Insertion and carving of materials

Finishing and Polishing

Program of Operative Treatment

Matrix Application

Tofflemire Matrix System

Ivory Matrix System

Matrix retainer, Band & Wedge

Matrix in Retainer

Contour Matrix

Rounded instrument

such as a spoon

excavator

Matrix on Tooth

Occlusal View

Wedge place

Contour Band

Ready for restoration

Cavity preparation

Matrix application

Preparation of materials

Insertion and carving of materials

Finishing and Polishing

Program of Operative Treatment

Armamentarium

Amalgam Capsule

Amalgamator

Squeeze Cloth

Amalgam carrier

Activate Mercury

Cavity preparation

Matrix application

Preparation of materials

Insertion and carving of materials

Finishing and Polishing

Program of Operative Treatment

Insertion and carving

Class Ⅰ

Class Ⅱ

Armamentarium

Amalgam Condensers

Anatomic Burnishers

Carves

— Cleoid or Discoid

Check condenser fit

First increment

Start with the smallest condenser

Step condenser over mass

Continue adding increment

Condense toward walls

Use alternative instruments

Overpacked

Create initial grooves

Create initial grooves

Carve to margin

Enhance grooves

Remove flash

Final shape and burnishing

Completed restoration

Initial Increment

Initial Condensation

Lateral Condensation

Overpacking

Marginal Ridge Condensation

Condense to Margins

Create Occlusal Embrasure

Occlusal Embrasure

Occlusal Embrasure

Occlusal Embrasure

Removing Ridge

Removing Band

Flash & Excess

Moving Excess

Check with interproximal carve

Instrument on Tooth Structure

Completed Restoration

Rubber dam removal

Cavity preparation

Matrix application

Preparation of materials

Insertion and carving of materials

Finishing and Polishing

Program of Operative Treatment

Polishing

Evaluate the restoration Class I

Verify that cavosurface margin can be seen

— Flash

— Underfilled

— Voids

Check the overall shape of the anatomy

— Look for bulky ridges that might be high

in occlusion

Evaluate the restoration Class II

Check proximal contact

Check flash and overhangs proximally

Check underfill proximally

Check outline form

Check Occlusion

Evaluate carefully with marking paper

or ribbon in Miller forceps

Check gently in centric occlusion

Check all excursive movement

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